Blood Gas Syringes Research Articles

A-116 Pleural Fluid pH - Are We Collecting and Measuring It Correctly?

Abstract Background Pleural fluid pH has diagnostic, therapeutic, and prognostic implications in the management of pleural space infections and malignancy. Pleural fluid sample collection, transportation and processing are known for source of pre-analytical error which contribute to inaccuracy of measured pH with clinical implication to patient care. Some clinical practices observed locally include pleural fluid collection in sterile container for ease of other biochemistry analytes measurement in addition to pH. This study aimed to compare the differences in pleural fluid pH and other commonly ordered biochemistry analytes collected using sterile container against heparinized blood gas syringe. Methods Total 20 Pleural fluid samples were collected from patient using a procedure called thoracentesis from, with approximately 2 to 3ml of fluid directly transferred into heparinized blood gas syringe as well as in a sterile container. Both samples were then transported to Clinical Biochemistry Laboratory within an hour. Both samples were analyzed on 3 analytical systems; 1) pH on Roche COBAS b221 blood gas analyzer, 2) Glucose, Total Protein, LDH on Beckman AU System and 3) Specific Gravity on Reflectometer. Statistical analysis was performed using Analyze-It software. Results pH fluid collected in sterile container demonstrates significant high bias (absolute of 0.4 units or 5%) as compared to sample collected in heparinizes blood gas syringe. Other commonly ordered tests in fluid profile (Glucose, Total Protein, LDH and SG) demonstrate good correlation (Altman-Bland Difference Plot <5%) for pleural fluid collected in sterile container as compared to heparinized syringe. Conclusions This positive bias observed is likely attributed to air exposure in pleural fluid collection in sterile container as compared to heparinized syringe. The accuracy of measured pleural pH is critically dependent on the method of sample collection. This study highlights the need for a standardized protocol for pleural pH collection for accurate measurement.

Impact of an air bubble within the syringe on test results obtained with a modern blood gas analyzer

Background. Minimizing air aspiration by carefully filling blood gas syringes is crucial to prevent air contamination from causing undesirable variations in gasses and other molecules. While some previous studies investigated this aspect, these are now outdated and only analyzed a limited number of blood gas parameters. Thus, we investigated the effects air contamination in the syringe using a modern blood gas analyzer. Methods. We sampled venous blood from 17 laboratory workers (mean age: 46±11 years; 10 women), filling two consecutive blood gas syringes. The first was filled exactly to its nominal volume (i.e., 1.0 mL), while the second was filled with 0.8 mL of blood and 0.2 mL of ambient air. Blood gas analysis was performed in each syringe using an identical analyzer. Results. In the syringe with the air bubble, we found statistically significant increase in pH (0.1%), pO2 (10.8%), SO2 (11.2%), total hemoglobin (3.0%), and hematocrit (2.7%), while values of pCO2 (-4.8%), sodium (-0.5%), and ionized calcium (-1.3%) were significantly reduced. With exception of pH, all these changes exceeded the performance specifications. Potassium, chloride, glucose, lactate, COHb and MetHb values remained unchanged. Conclusion. These findings confirm that air bubbles must be removed as soon as possible after sampling from blood gas syringes to prevent artifactual test results and misleading clinical judgment and inappropriate treatment. When blood gas syringes are received in the laboratory with air bubbles inside, the most vulnerable parameters (i.e., pO2, SO2, pCO2, sodium, ionized calcium, hematocrit and hemoglobin) should be suppressed.

Effect of exogenous lipids contamination on blood gas analysis.

The purpose of this study was to investigate theeffects of contamination of venous blood with a lipid-containing solution on parameters measured by a modern blood gas analyzer. We collected venous blood from 17 healthcare workers (46±11years; 53 % women) into three blood gas syringes containing 0 , 5 and 10 % lipid-containing solution. Blood gas analysis was performed within 15 min from sample collection on GEM Premier 5000, while triglycerides and serum indices were assays on Roche COBAS C702. Triglycerides concentration increased from 1.0±0.3 mmol/L in the uncontaminated blood gas syringe, to 39.4±7.8 and 65.3±14.4 mmol/L (both p<0.001) in syringes with 5 and 10 % final lipid contamination. The lipemic and hemolysis indices increased accordingly. Statistically significant variation was noted for all analytes except hematocrit and COHb in the syringe with 5 % lipids, while only COHb did not vary in the syringe with 10 % lipids. Significant increases were observed from 5 % lipid contamination for pO2, SO2 and lactate, while the values of pH, pCO2, sodium, potassium, chloride, ionized calcium, glucose, hematocrit (10 % contamination), hemoglobin and MetHB decreased. All these changes except lactate and CoHb exceeded their relative performance specifications. Artifactual hyperlipidemia caused by contamination with exogenous lipids can have a clinically significant impact on blood gas analysis. Manufacturers of blood gas analyzers must be persuaded to develop new instruments equipped with serum indices.

Is mixing of blood gas syringes after collection really necessary?

Is mixing of blood gas syringes after collection really necessary?

Effect of syringe underfilling on the quality of venous blood gas analysis.

There is limited information on the influence of collecting small amounts of blood on the quality of blood gas analysis. Therefore, the purpose of this study was to investigate the effects of different degrees of underfilling of syringes on test results of venous blood gas analysis. Venous blood was collected by venipuncture from 19 healthcare workers in three 1.0 mL syringes for blood gas analysis, by manually aspirating different volumes of blood (i.e.,1.0, 0.5 and 0.25 mL). Routine blood gas analysis was then immediately performed with GEM Premier 5,000. The results of the two underfilled syringes were compared with those of the reference syringe filled with appropriate blood volume. The values of most assayed parameters did not differ significantly in the two underfilled syringes. Statistically significant variations were found for lactate, hematocrit and total hemoglobin, the values of which gradually increased as the fill volume diminished, as well as for sodium concentration, which decreased in both insufficiently filled blood gas syringes. The bias was clinically meaningful for lactate in syringe filled with 0.25 mL of blood, and for hematocrit, total hemoglobin and sodium in both syringes containing 0.5 and 0.25 mL of blood. Collection of smaller volumes of venous blood than the specified filling volume in blood gas syringes may have an effect on the quality of some test results, namely lactate, hematocrit, total hemoglobin and sodium. Specific indications must be given for standardizing the volume of blood to be collected within these syringes.

Impact of blood collection devices and mode of transportation on peripheral venous blood gas parameters

BackgroundPeripheral venous blood (PVB) gas analysis has become an alternative to arterial blood gas (BG) analysis in assessing acid-base balance. This study aimed to compare the effects of blood collection devices and modes of transportation on peripheral venous BG parameters. MethodsPVB-paired specimens were collected from 40 healthy volunteers into blood gas syringes (BGS) and blood collection tubes (BCT), transported by either a pneumatic tube system (PTS) or human courier (HC) to the clinical laboratory, and compared using a two-way ANOVA or Wilcoxon signed-rank test. To determine clinical significance, the PTS and HC-transported BGS and BCT biases were compared to the total allowable error (TEA). ResultsPVB partial pressure of oxygen (pO2), fractional oxyhemoglobin (FO2Hb), fractional deoxyhemoglobin (FHHb), and oxygen saturation (sO2) showed statistically significant differences between BGS and BCT (p < 0.0001). Compared to HC-transported BGS and BCT, statistically significant increases in pO2, FO2Hb, sO2, oxygen content (only in BCT) (all p < 0.0001), and base excess extracellular (only in BCT; p < 0.0014) concentrations and a statistically significant decrease in FHHb concentration (p < 0.0001) were found in BGS and BCT delivered by PTS. The biases between PTS- and HC-transported BGS and BCT exceeded the TEA for many BG parameters. ConclusionsCollecting PVB in BCT is unsuitable for pO2, sO2, FO2Hb, FHHb, and oxygen content determinations.

An outbreak of Ralstonia insidiosa bloodstream infections caused by contaminated heparinized syringes

IntroductionRalstonia insidiosa, a gram-negative waterborne bacteria able to survive and grow in any type of water source, can cause nosocomial infections, and are considered emerging pathogens of infectious diseases in hospital settings. In this study, we report an outbreak of R. insidiosa at our center related to contaminated heparinized syringes. Material and methodsThe present study was conducted in a tertiary care university hospital in Turkey. An outbreak analysis was performed between September 2021 and December 2021. Microbiological samples were obtained from environmental sources and from patient blood cultures. Species identification was performed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). To investigate the clonality of strains, all confirmed isolates were sent to the National Reference Laboratory and pulsed-field gel electrophoresis (PFGE) was used to perform molecular typing. ResultsSeventeen R. insidiosa isolates were identified from the blood cultures of 13 patients from various wards and intensive care units. Isolates from seven patient blood cultures and two heparinized blood gas syringes were characterized by PFGE. All isolates were found to belong to the same clone of R. insidiosa. ConclusionR. insidiosa was identified as the cause of a nosocomial infection outbreak in our hospital, which was then rapidly controlled by the infection-control team. When rare waterborne microorganisms grow in blood or other body fluid cultures, clinicians and the infection-control team should be made aware of a possible outbreak.

Stability of pH, Blood Gas Partial Pressure, Hemoglobin Oxygen Saturation Fraction, and Lactate Concentration.

BackgroundThe storage temperature and time of blood gas samples collected in syringes constitute preanalytical variables that could affect blood gas or lactate concentration measurement results. We analyzed the effect of storage temperature and time delay on arterial or venous blood gas stability related to pH, partial pressure of carbon dioxide (pCO2) and oxygen (pO2), hemoglobin oxygen saturation (sO2), and lactate concentration.MethodsIn total, 1,200 arterial and venous blood sample syringes were analyzed within 10 minutes of collection. The samples were divided into different groups to determine parameter stability at 25, 4–8, and 0–3.9°C and at different storage times, 60, 45, 30, and 15 minutes. Independent sample groups were used for each analysis. Percentage deviations were calculated and compared with acceptance stability limits (1.65× coefficient of variation). Additionally, sample group sub analysis was performed to determine whether stability was concentration-dependent for each parameter.ResultsThe pH was stable over all storage times at 4–8 and 0–3.9°C and up to 30 minutes at 25°C. pCO2 was stable at ≤60 minutes at all temperatures. pO2 was stable for 45 minutes at 0–3.9°C, and sO2 was stable for 15 minutes at 25°C and for ≤60 minutes at 0–3.9°C. Lactate concentration was stable for 45 minutes at 0–3.9°C. Subanalysis showed that stability was concentration-dependent.ConclusionsThe strictest storage temperature and time criteria (0–3.9°C, 45 minutes) should be adopted for measuring pH, pCO2, pO2, sO2, and lactate concentration in blood gas syringes.

A comparison of venous blood gas analysis with paired specimens collected in syringes and evacuated blood collection tubes

BackgroundVenous blood samples collected in evacuated blood collection tubes are generally not considered suitable for measurement of oxygenation status. However, whether pH, pCO2 and HCO3– results from venous blood samples collected in evacuated tubes are reliable remains unclear. MethodsPaired samples were collected from 38 healthy volunteers using two collection methods: (1) collection of blood directly into a blood gas syringe and (2) collection of blood into an evacuated tube with subsequent anaerobic transfer into a blood gas syringe. Samples were analyzed for pH, pCO2, HCO3–, and pO2. ResultsSamples collected in evacuated tubes showed significant positive mean biases of 0.03 and 7.5 mmHg for pH and pO2, respectively, and significant negative mean biases of 5.0 mmHg and 1.2 mmol/l for pCO2 and HCO3–, respectively. Collection in evacuated tubes resulted in biases exceeding the total allowable errors in 16%, 40%, 21% of samples for pH, pCO2, HCO3–, respectively, when compared to samples collected in syringes directly. ConclusionsSamples for venous blood gas analysis should be collected directly into blood gas syringes for accurate assessment of ventilation and/or acid-base status. Biases observed for samples collected in evacuated tubes are consistent with air contamination and/or vacuum effects.

Interchangeability of Electrolyte and Metabolite Testing on Blood Gas and Core Laboratory Analyzers.

Using blood gas (BG) analyzers as backups for core laboratory analyzers has the potential to greatly reduce turnaround times and costs. One venous blood gas syringe, one plasma separator tube (PST), and one serum separator tube (SST) were drawn from 42 healthy individuals. All samples were run on the GEM4000 BG analyzer whereas the PST and SST samples were also run on the Roche Modular chemistry analyzer. Blood electrolyte and metabolite parameters were compared for paired measurements, and their differences were assessed for statistical and clinical significance. Whole blood on GEM4000 and plasma/serum on Roche Modular produced incomparable results for Na+ in plasma and serum (2.5 percentile difference, GEM4000 - Modular: -4.975 and -4.95 mmol/L, respectively) and K+ in serum (2.5 percentile difference, GEM4000 - Modular: -0.7975 mmol/L). When comparing whole blood to plasma/serum samples, all from the GEM4000, incomparable parameters were also found for Cl- in plasma and serum (97.5 percentile difference, plasma or serum - whole blood: 6 and 5 mmol/L, respectively), and K+ in serum (97.5 percentile difference, serum - whole blood: 0.7 mmol/L). None of the parameter differences when comparing plasma/serum results on the GEM4000 to those on the Roche Modular were found to be clinically significant. The off-label use of plasma/serum on a BG analyzer produced electrolyte and metabolite measurements that were more interchangeable with standard core laboratory analyzer results than with its designated whole blood samples. The interchangeability of results, therefore, seems to be affected more by different sample types than by different measurement methods.

Arterial blood gas sampling: using a safety and pre-heparinised syringe.

Taking arterial blood gases (ABG) is an essential part of the diagnosis and management of critically ill patients. An arterial blood sample is collected from an artery, primarily to determine the ABGs. Health professionals should only undertake this if the procedure is in the legal scope of practice for their profession in their country, and they have demonstrated skilled, proficient, safe practice after formal training. Blood samples can be obtained via an arterial catheter inserted into an artery or percutaneously by using a needle to directly puncture into the artery. This article provides an overview of this subject area. It includes case studies where the Pulsator Plus Arterial Blood Gas Syringe (Smiths Medical) was used to safely and effectively collect blood samples for analysis.

Determination of reference intervals and comparison of venous blood gas parameters using a standard and nonstandard collection method in 51 dogs.

The aim of this study was to determine reference intervals (RI) for venous blood parameters determined with the RAPIDPoint 500 (RP500) blood gas analyzer using blood gas syringes (BGS) and to determine whether immediate analysis of venous blood collected into lithium heparin (LH) tubes can replace anaerobic blood sampling into BGS. The null hypothesis was that canine venous blood samples collected in BGS and in LH tubes are comparable. Jugular blood was collected from 51 healthy dogs into a BGS and a LH tube. The BGS was immediately analyzed followed by the LH tube. The RI were calculated from BGS results. The BGS and LH tubes results were compared using paired t-test or Wilcoxon matched-pairs signed-rank test and Bland-Altman analysis. To assess clinical relevance, the bias between BGS and LH tubes was compared with the allowable total error (TEa). Values derived from LH tubes showed no significant difference for standard bicarbonate (HCO3std), whole blood base excess (BE B), Na, K, Cl, glucose and hemoglobin (tHb). The pH, partial pressure of carbon dioxide and oxygen, actual bicarbonate, extracellular base excess, ionized Ca, anion gap and lactate were significantly (p.

Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel.

Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel.

The (in-)validity of volatile POCT parameters from patients beyond normothermia

BackgroundA common characteristic of all blood gas analyzers on the market is that measurements are processed at 37°C, not at the real patients´ temperature. Subsequently temperature-sensitive parameters can be mathematically corrected (alpha-stat method) or used directly (pH-stat method). National rules in Germany (Rili-BAEK) demand defined accuracy and precision without any restriction to samples´ temperatures or corrections. As consequence in the investigation at hand we tried to find out whether blood gas analyzers can fulfill the regulations for pCO2 and pO2 when normothermia of the matrix is not given. MethodsFive matrices (blood from intensive care unit (ICU) patients, blood from healthy donors and 3 levels of bovine based quality control material) were tonometered at “high” and “low” partial pressures of O2 and CO2 within the RiLi-BAEK controlled range at 32, 37 and 40°C. One mL material was aspired into each blood gas (BG) syringe and analysis was accomplished immediately after. The procedure was repeated 10-fold for “high” and “low” gas concentrations and run on 4 different analyzers. At 18°C instead to the “high” one a “median” gas (n=10 as well) was employed. Every condition which constitutes of temperature (4), matrix (5), analyzer (4) and level of the partial pressure (2) led to a total of 1600 measurements. ResultsAt 32°C or 37°C matrix temperature 7.5% to 27.5% of the pCO2(T) and between 14.5% and 28.1% of the pO2(T) results were outside the borders required by the RiLi-BAEK. At 18°C or 40°C the number of results beyond the allowed borders grows up to 82.5% for pCO2(T) and 73% for pO2(T) depending on the partial pressure (PP) level. ConclusionsHigh precision in automated quality control (at a constant matrix temperature) is given in modern BGAnalyzers but is counteracted in practice by non normothermic patient's temperature and unavoidable sample handling effects.

Plastic Blood Gas Syringes and Measurement Error in Central Venous Oxygen Saturations.

Measurement of central venous oxygen (SvO2) levels remains an important method for the detection of circulatory shock. Plastic blood gas syringes have supplanted glass. These syringes are, however, permeable to atmospheric oxygen. Common sampling practices, including a delay between blood aspiration and analysis and continuous mixing of the sample, may promote equilibration of the blood sample with atmospheric oxygen and could result in over estimation of SvO2 levels. Pulmonary artery or central venous catheter blood samples were taken from 21 critically ill patients. Two venous blood gas samples were collected simultaneously in plastic syringes. One sample was continuously mixed through a gentle rotation. The other sample was not mixed. Blood gas analyses were undertaken on both samples at baseline and at 5, 10, 15, and 20 min. Compared with baseline levels, the SvO2 increased significantly over time for both continuously mixed and nonmixed samples (P < 0.0001). The rate of the increase was 2-fold greater for continuously mixed samples (P < 0.0001). For continuously mixed samples, the SvO2 was 63% at baseline, 65% at 5 min, 70% at 10 min, 74% at 15 min, and 78% at 20 min. For the nonmixed samples, the levels were 63%, 64%, 66%, 68%, and 70%, respectively. This is the first report documenting that plastic blood gas syringes systematically overestimate SvO2 levels when there is a delay in analysis or continuous mixing of the sample. Overestimation of SvO2 levels may harm patients as circulatory shock may not be recognized and treated.

Safe Reduction of Blood Volume in the Blood Gas Laboratory.

Phlebotomy is a significant cause of iatrogenic anemia in the critical care environment. It is estimated that one-third of all transfusions of packed red blood cells in intensive care units (ICU) result from phlebotomy. The aims of this study were to determine if utilizing the 1mL blood gas syringe for an adult population would impact the rate at which specimens were acceptable for testing and result reporting based on lab specimen rejection criteria; and to compare blood utilization between the 2 different syringes. This study was conducted in 1 of the adult ICUs at the University of Utah Hospital. Over a baseline period a standard adult 3 mL blood gas syringe was utilized. Subsequently the standard adult syringe was replaced by a 1 mL syringe produced by the same manufacturer with the same heparin concentration. The change to the 1 mL syringe had no effect on specimen integrity in regards to laboratory's ability to process the specimen. With use of the 1 mL syringe there was a 60% reduction in the volume of blood drawn compared with the baseline period. Standardizing the 1 mL syringe for Blood Gas Laboratory tests will reduce patient blood loss without appreciably affecting specimen rejection relative to current rates.

Analytical evaluation of the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients

ObjectivesThe aim of this study was to evaluate the analytical performance of the new epoc® point-of-care blood analysis system in cardiopulmonary bypass patients. Design and methodsThe precision study was conducted on 3 epoc® blood analysis systems using 5 levels of quality control materials twice per day for 5days. The blood specimen was collected in blood gas syringes from 40 cardiac perfusion patients for the comparison study on epoc® (all 3meters), Instrumentation Laboratory GEM4000, Abbott iSTAT, Nova CCX, and Roche Accu-Chek Inform II and Performa glucose meters. ResultsThe epoc® blood analysis systems demonstrated clinically acceptable precision for all analytes (from 0.07%, 0.07%, and 0.13% for pH7.6, 7.4, and 7.0 levels; to 3.87%, 3.74%, and 7.56% for pO2 197, 103, and 56mmHg levels). Comparison studies yielded a correlation coefficient R from 0.9201 (sodium) to 0.9969 (pO2) with the GEM4000; from 0.9071 (sodium) to 0.9965 (potassium) with the iSTAT; from 0.8793 (sodium) to 0.9957 (pO2) with the CCX, and 0.9850 and 0.9904 with Roche Inform II and Performa meters respectively. Average biases for all analytes were within the total allowable error limits. ConclusionThe epoc® blood analysis system is acceptable for point-of-care testing in the cardiovascular surgery setting.

How to Solve the Underestimated Problem of Overestimated Sodium Results in the Hypoproteinemic Patient

The availability of a fast and reliable sodium result is a prerequisite for the appropriate correction of a patient's fluid balance. Blood gas analyzers and core laboratory chemistry analyzers measure electrolytes via different ion-selective electrode methodology, that is, direct and indirect ion-selective electrodes, respectively. Sodium concentrations obtained via both methods are not always concordant. A comparison of results between both methods was performed, and the impact of the total protein concentration on the sodium concentration was investigated. Furthermore, we sought to develop an adjustment equation to correct between both ion-selective electrode methods. A model was developed using a pilot study cohort (n = 290) and a retrospective patient cohort (n = 690), which was validated using a prospective patient cohort (4,006 samples). ICU and emergency department at Ghent University Hospital. Patient selection was based on the concurrent availability of routine blood gas Na⁺(direct) as well as core laboratory Na⁺(indirect) results. In the pilot study, left-over blood gas syringes were collected for further laboratory analysis. There was a significant negative linear correlation between Na⁺(indirect) and Na⁺(direct) relative to changes in total protein concentration (Pearson r = -0.69; p < 0.0001). In our setting, for each change of 10 g/L in total protein concentration, a deviation of ~1.3 mmol/L is observed with the Na⁺(indirect) result. Validity of our adjustment equation protein-corrected Na⁺(indirect) = Na⁺(indirect) - 10.53 + (0.1316 × total protein) was demonstrated on a prospective patient cohort. As Na⁺(direct) measurements on a blood gas analyzer are not influenced by the total protein concentration in the sample, they should be preferentially used in patients with abnormal protein concentrations. However, as blood gas analyzers are not available at all clinical wards, the implementation of a protein-corrected sodium result might provide an acceptable alternative.

23 NEONATAL SUPPORT THERAPY AND BLOOD GAS EVALUATION IN CLONED AND ARTIFICIAL INSEMINATION-DERIVED NEWBORN CALVES

Offspring derived from artificial reproductive techniques are already known to present several postnatal undesirable phenotypes and clinical disorders. Despite its benefits, cloning by somatic cell nuclear transfer (SCNT) is extremely inefficient. The birth rate in cattle is around 5% of the transferred blastocysts, and ~50% of delivered calves die in the first 48 h. Neonatal respiratory distress is reported to be one of the main causes of such deaths. Veterinary intervention is often needed to promote or improve blood oxygenation, avoiding respiratory acidosis and improving carbon dioxide delivery from blood/lungs to the environment. This study aimed to evaluate a neonatal support therapy over the blood gas and acid-base balance on newborn calves derived from SCNT or AI. Four cloned and 3 AI-derived calves delivered by Caesarean section were used for the experiment. Postnatal therapeutic procedures were comprised 4 doses of 400 mg of intratracheal surfactant every 15 min, 25 mg of oral sildenafil every 8 h for 3 days, and 5 L min–1 intranasal oxygen. Blood collections were performed within 30 min (T0), at 12 (T12), 24 (T24) and 48 (T48) hours after delivery. Blood samples were collected from the caudal auricular artery with a butterfly and a blood gas syringe. Oxygen saturation (sO2), arterial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), pH, and bicarbonate (HCO3–) were evaluated with a portable blood gas analyzer (i-STAT, Abbott Point of Care Inc., Princeton, NJ, USA). Data obtained were submitted to ANOVA (Proc MIXED; SAS/STAT, version 9; SAS Institute Inc., Cary, NC, USA). There were significant differences between groups in blood pH (P = 0.0182) and between groups (P = 0.0281) and time of collection (P = 0.0303) in blood bicarbonate (HCO3–). The AI calves were born with normal pH (7.468 ± 0.033) and the cloned calves were born in acidosis (7.216 ± 0.166). These calves were stabilised in T48 (7.427 ± 0.017) using their own HCO3– that increased over time. Although there were no differences in sO2 (P = 0.4525), PaO2 (P = 0.3086), or PaCO2 (P = 0.2514), sO2 and PaO2 were numerically increased at the same time that PaCO2 decreased in both groups. In the cloned calves, the sO2, PaO2, and PaCO2 at T0 were 61.3 ± 28.6%, 39.8 ± 18.5 mmHg, and 65.8 ± 29.3 mmHg, respectively and reached 90.0 ± 3.4%, 57.7 ± 15.8 mmHg, and 42.0 ± 3.7 mmHg. In the AI calves, T0 blood gas analysis were 79.8 ± 19.4%, 56.1 ± 42.1 mmHg, and 39.1 ± 4.8 mmHg, and at T48 were 89.0 ± 2.6%, 82.3 ± 43.5 mmHg, and 43.0 ± 4.9 mmHg for sO2, PaO2, and PaCO2 respectively. The neonate support therapy improved calves' oxygenation and helped to eliminate the carbon dioxide from the blood. In our experience, the neonatal treatment was essential in supporting the lives of the cloned calves.Funding support was received from FAPESP 2011/19543–9.

The comparison of heparinized insulin syringes and safety-engineered blood gas syringes used in arterial blood gas sampling in the ED setting (randomized controlled study)

IntroductionThe arterial blood gas measurement process is a painful and invasive procedure, often uncomfortable for both the patient and the physician. Because the patient-related factors that determine the difficulty of the process cannot be controlled, the physician-related factors and blood gas measurement techniques are a modifiable area of improvement that ought to be considered. Many hospitals use insulin syringes or syringes washed with heparin for the purpose of blood gas measurement because they do not have blood gas–specific syringes. In this prospective cross-sectional study, we aimed to compare safety-engineered blood gas syringes and conventional heparinized syringes used during the arterial blood gas extraction process in terms of ease of operation, the physician-patient satisfaction, laboratory appropriateness, and complications. MethodsOur study included patients whose arterial blood gas needed to be measured in the emergency department and who agreed to participate in the study. Patients were randomly divided into 2 groups. The arterial blood gas of the patients from the first group was measured by using conventional heparinized syringes, whereas safety-engineered blood gas syringes were used to measure the arterial blood gas of the patients from the second group. The groups were compared in terms of demographic data, the number of attempts, the physician and patient satisfaction, early and late-term complications, and laboratory appropriateness of the taken sample. ResultsA total of 550 patients were included in our study in a 2-month study period. There were no significant differences between patients in terms of sex, age, weight, height, body mass index, and wrist circumference. In addition, the number of attempts (P=.489), patients' pain level during the procedure (P=.145), and the degree of difficulty of the procedure according to the patient (P=.109) and physician (P=.554) were not significantly different between the groups. After arterial blood gas extraction procedure, 115 patients (20.9%) developed complications. In the conventional heparinized syringe group, the complication rate (n=69; 25.1%) was significantly higher compared with the group that used safety-engineered blood gas syringes (n=46; 16%; P=.0211). Localized pain, which is one of the most common early complications, was more frequent in the conventional heparinized syringe group (19.3%). Complications in women (P=.003) and local pain (P=.01) developed lesser in the second group that used safety-engineered blood gas syringes, and the patient-physician satisfaction was higher in that group, as well. In the evaluation 48 hours after the procedure, the ratios of infection and local hematoma were higher in the conventional heparinized syringe group (P=.0213 and P < .0001). ConclusionIn this study, we did not find any significant differences between the conventional heparinized syringes and safety-engineered blood gas syringes in terms of ease of operation, physician and patient satisfaction, and appropriateness of the taken sample. However, patients whose arterial blood gas was extracted by using safety-engineered blood gas syringes felt less pain and experienced fewer infections and hematomas at their puncture site.